The Time to Live Report calls for doctors to adopt guidelines and re-prioritise their approach in COPD management. Over 90% of doctors interviewed as part of the Time to Live Report agreed that reducing exacerbations ("lung attacks") in COPD is vital to improve patients' quality of life and 70% think that reducing hospital visits is crucial. (1, 2) However, despite updated guidelines and advances in treatment, a quarter of COPD patients hospitalised with an exacerbation will be dead within a year(3,4), and more than 90% of sufferers report that exacerbations affect their daily life. (5)
Exacerbations are an acute worsening of symptoms, often triggered by a respiratory infection, requiring medical intervention and often hospitalisation. However, while doctors do see the need to reduce exacerbations, when it comes to management strategies for the condition 81% of doctors interviewed for the report still regard every day symptomatic relief as the best treatment option. This suggests that preventing and reducing exacerbations is still not enough of a priority in COPD management.
Dr Alfred Loh, Chief Executive Officer of Wonca comments: "The Time to Live Report demonstrates the need to refocus the way in which clinicians view and treat COPD. The level of care provided to patients with COPD, and the morbidity and mortality associated with the condition, is truly unacceptable. We urgently need to change the prevailing attitude that COPD is a hopeless condition with limited treatment options. Advances in treatment and our ever-increasing understanding of COPD means it is a condition that is both preventable and treatable. The great news is that evidence shows family doctors can make a huge difference to the lives of people with COPD and their families by focussing on reducing the number and severity of exacerbations they have to suffer."
Recommendations on how to treat COPD have been set out in evidence-based guidelines such as those developed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). (6) The International Primarycare Airways Group Handbook (IPAG) Handbook, officially launched in May 2005 at the Wonca Asia-Pacific Regional Conference in Kyoto, Japan, also provides family doctors with practical guidelines on the medicine-based management of COPD. Despite acknowledgment by clinical bodies that exacerbations are a key treatment goal for COPD, results from a recent survey included in the Time to Live Report demonstrated a considerable difference between targets set out in guidelines and clinical practice.
- 90% of doctors believe reducing exacerbations is vital to improve patient's HRQoL
- 89% agree prevention of exacerbations is key when considering choice of therapy
- 89% agree slowing down disease progression should be the primary goal in COPD
Despite this:
- 81% still regard symptomatic relief as the best option for treating COPD
- One quarter of GPs are unaware of the new guidelines
- 66% of doctors still believe patients must accept that their disease can not be managed. (2)
Dr John Haughney, GP in Glasgow, Scotland, Chairman of the UK General Practice Airways Group and co-author of the Time to Live Report, comments: "Preventing exacerbations is identified as a key goal for the effective management of COPD, yet the Time to Live Report reveals there is still confusion about the principal aims of COPD management. Due to outdated beliefs about the benefits of therapeutic interventions in COPD and a failure to implement best practice, many patients continue to suffer unnecessarily. Reducing the frequency and severity of exacerbations, and treating them aggressively and effectively, is even more important than long term symptom management, and should be the main focus of treatment if we are to reduce the burden imposed on patients and healthcare resources by COPD."
Professor Thys van der Molen, GP, Professor at the Department of General Practice at the University of Groningen, Professor of Primary Care Respiratory Medicine at the University of Aberdeen and Time to Live Report co-author adds: "When considering therapeutic options, doctors should focus on ensuring they recommend treatments based on their ability to reduce the burden of exacerbations as well as providing symptomatic relief. This strategy will eventually lead to a better outcome since exacerbations have a negative influence on patients' quality of life that can last up to 6 months after the exacerbation. If we want to put the patient first, and give them the best possible outcome, we must ensure we tackle both aspects of this debilitating condition rather than just symptoms alone."
Traditional COPD therapies previously recommended for the treatment of COPD, such as short-acting bronchodilators, help to relieve acute symptoms. Recent evidence has shown treatment with both a long-acting bronchodilator and an inhaled corticosteroid - in particular when individual components are used in combination - not only provides symptomatic relief, but also significantly reduces the frequency and severity of COPD exacerbations, events which are known to be a major contributor towards worsening of lung function. (7, 8)
Notes to Editors
The Time to Live Report is supported by an unrestricted educational grant from AstraZeneca. AstraZeneca are the manufacturers of Symbicort®, a combination of the inhaled corticosteroid budesonide and rapid- and long-acting beta-agonist formoterol, which is indicated for the treatment of COPD and asthma.
Exacerbations in COPD
COPD is a disease characterised by airflow limitation that is not fully reversible. In addition to their everyday symptoms, patients with COPD suffer from periods of worsenings known as exacerbations. In general, patients with severe COPD experience exacerbations more frequently than those with mild disease. An exacerbation is a deterioration in a patient's clinical status, with acute worsenings of respiratory symptoms, such as coughing, wheezing, sputum production and shortness of breath and impaired lung function and are classified by patients as events they wish to avoid most, even more important than improvement of symptoms. Exacerbations are also accompanied by increase in non-respiratory symptoms such as fatigue, malaise, insomnia, depression, anxiety and confusion.
For patients with severe COPD, exacerbations tend to be associated with cardiac symptoms in addition to respiratory symptoms. As disease severity increases, exacerbations occur with greater frequency and severity contributing towards an irreparable decline in lung function, deterioration in health-related quality of life and an increased risk of hospitalisation. Events can undermine a patient's condition for weeks or even months and are a key driver of premature death. (7) Recent studies have shown patients hospitalised with acute exacerbations of COPD have poor short and long-term survival, with almost half dying within three years. (9) For example, amongst patients admitted to an Intensive Care Unit following an exacerbation, in-hospital mortality rate was 24.5 per cent - a figure which rose to 42.5 per cent one year after exacerbation. (10) Their associated costs also present a huge economic burden on the healthcare system; around 35 to 45 per cent of total expenditure per COPD patient can be attributed to acute exacerbations. (11,12,13)
About Wonca
Wonca is acronym comprising the first five initials of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians. Wonca's short name is World Organization of Family Doctors. Wonca is made up of national colleges, academies or organizations concerned with the academic aspects of general family practice. Beginning with 18 members in 1972, there are now 105 member organizations in 89 countries. This includes eight organizations in collaborative relations with Wonca. In all, the total membership of the member organizations of Wonca is over 200,000 general practitioners/family physicians whose practices cover over 80% of the world's population. Wonca represents and acts as an advocate for its constituent members at an international level where it interacts with world bodies such as the World Health Organization.
Wonca is partnering with AstraZeneca to support the distribution, dissemination, and discussion of the Time to Live Report.
About Astrazeneca
AstraZeneca is a major international healthcare business engaged in the research, development, manufacture and marketing of prescription pharmaceuticals and the supply of healthcare services. It is one of the world's leading pharmaceutical companies with healthcare sales of over $21.4 billion and leading positions in sales of gastrointestinal, cardiovascular, respiratory, oncology and neuroscience products. AstraZeneca is listed in the Dow Jones Sustainability Index (Global) as well as the FTSE4Good Index.
References
1 Time to Live report
2 Synovate GP Omnibus. 250 GPs in France, Germany, Spain, UK and Italy. Conducted April/May 2005
3 Almagro P, Calbo E, de Echagüen AO, Barreiro B, Quintana S, Heredia JL, Garau J. Mortality After Hospitalization for COPD. Chest 2002; 121 (5): 1441-48
4 Wouters EF. Economic analysis of the Confronting COPD survey: an overview of results. Respir Med. 2003 Mar; 97 Suppl C:S3-14.
5 Vogelmeier C, Partridge MR, Stahl E. Burden of exacerbations in COPD: the patient's perspective. Presented at the American Thoracic Society meeting 2004
6 Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2004 update. NHLBI/WHO workshop report (NIH publication No. 2701). Bethesda, MD: National Institutes of Health (NIH); 2004.
7 Cooper CB, Tashkin DP. Recent developments in inhaled therapy in stable chronic obstructive pulmonary disease. BMJ 2005;330;640-644
8 Tashkin DP, Cooper CB. The role of long-acting bronchodilators in the management of stable COPD. Chest 2004;125:249-59
9 Gunen H et al. Factors affecting survival of hospitalised patients with COPD. European Respiratory Journal 2005; 123: 234-241
10 Chua Ai-Ping et al. In-hospital and 5-year mortality of patients treated in the ICU for acute exacerbation of COPD. Chest 2005; 128: 518 - 524
11 Andersson F, Borg S, Jansson SA et al. The costs of exacerbations in chronic obstructive pulmonary disease (COPD). Respir Med 2002; 96: 700–8
12 Jansson SA, Andersson F, Borg S et al. Costs of COPD in Sweden according to disease severity. Chest 2002; 122: 1994–2002
13 Hilleman DE, Dewan M, Malesker M, Friedman M. Pharmacoeconomic evaluation of COPD. Chest 2000; 118: 1278–82